I. The Case for Clinician Well-Being
Clinician well-being has emerged as a national priority¹ due to its significant consequences for patients, health care organizations, and clinicians themselves. In particular, burnout has been a primary focus of scholarship. A prolific body of literature characterizing burnout in physicians and physicians in training has revealed its negative impact on the quality, safety and experience of care for patients.² ³ ⁴ ⁵ ⁶ Burnout also has grave effects for physicians, whose rate of suicide exceeds the rate of other professionals and is double that of the general population. ⁷ ⁸
Beyond these serious health ramifications, a small but compelling body of literature from Shanafelt and others has revealed the fiscal impact of physician burnout on health care organizations. Specifically, burnout has been associated with both reduced productivity and attrition of physicians from the practice of medicine.⁹ ¹¹ There is thus a clear business case motivating health care organizations to invest in physician well-being.¹⁰
Taken together, these findings reveal burnout’s threat to the ‘triple aim’ — the Institute of Medicine’s compass for health system performance that targets improved quality, cost and experience of care for patients.¹² ¹³ In response, thought leaders have developed conceptual models for physician well-being to identify areas for intervention.¹⁴ However, the National Academy of Medicine (NAM) and other policy makers have broadened this work, recognizing the challenges faced by physicians are also encountered by nurses and other clinicians.¹ ¹⁵ The culmination of these efforts has been a revision of the triple aim to include care team well-being as a fourth performance metric, recognizing it is a prerequisite for health system outcomes in quality, cost and experience.¹³
This ‘Quadruple Aim’¹³ represents a significant achievement for well-being policy, as it signals a paradigm shift in clinician well-being. Indeed, the Quadruple Aim translates well-being from an individual construct — with a primary impact on providers — to a systems-level construct with significant ramifications for health system performance. As a result of this shift, it is no longer sufficient for organizations to rely on provider-level interventions. Rather, health systems must confront clinician well-being at all levels of the organization.
II. Anticipating the Impact of Covid-19
The impact of the Covid-19 pandemic on clinician well-being remains uncertain. Incredibly, a recent perspective piece in the New England Journal of Medicine speculated it may have positive effects, as the pandemic has renewed physicians’ sense of autonomy and altruism and thus may mitigate burnout.16However, the face validity of these arguments is hard to believe without substantial evidence.
The limited data available suggest Covid-19 has had a much harsher impact. In fact, a recent publication by the NAM Collaborative on Clinician Well-being and Resilience argued that the health care industry is in danger of a parallel pandemic related to clinician well-being as a consequence of Covid-19.¹⁷ It is easy to understand this threat — particularly given the tragic reports of clinicians dying by suicide in pandemic-stricken cities like New York.¹⁷ Social media and other outlets have also experienced a steady stream of health care professionals’ citing deep fears for their own health, as well as the health of family members. Indeed, front line workers facing Covid-19 have been likened to the heroic volunteers who responded to the World Trade Center attacks, as both groups have risked their physical and mental health to serve others in need.¹⁷
If prior disaster scenarios such as the 2003 SARS outbreak or the 2011 Fukushima Daiichi nuclear disaster offer any benchmark indication, Covid-19 will likely result in high levels of emotional distress for health care workers due to social isolation, loss of peers to the disease, and social stigma — among other factors.¹⁷ As such, it is likely that clinician burnout will increase following the pandemic — to the detriment of health system performance.
III. A Call to Arms for Health Care Organizations
Health care organizations face many challenges in the era of Covid-19. These range from mitigating operational and financial uncertainty, to rapidly testing and scaling effective changes for care delivery.¹⁸ In this environment of continuous change, health systems have a unique mandate for cultural agility. They must quickly identify and address both helpful and harmful factors affecting the organization, with a goal of cultivating system resilience.¹⁹ ²⁰ ¹² ²²
Organizations should leverage this unique period to establish clinician well-being as a key performance indicator — both during the pandemic and beyond. As the NAM outlines, clinician well-being should be considered in the crisis response of any health system. This includes having the chief wellness officer or designated well-being leader in the ‘command center;’ and sustaining and supplementing existing well-being programs.¹⁷ Organizations must also identify strategies for fulfilling the Quadruple Aim beyond the pandemic. Routine assessments of burnout will be critical to these efforts, along with shared accountability for well-being among organizational leaders.¹⁰ Without these measures in place, clinician well-being may indeed become a parallel crisis of unprecedented proportions.
As seen on Medium
Authors: Meghan Galligan (A Philadelphia-area Pediatrician), Toomas Truumees (Founder, Adaptive Strategic), Wesley Palmer (Co-Founder, Adaptive Strategic)
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